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Disease-free survival of patients with muscle invasive bladder cancer treated with radical cystectom

Disease-free survival of patients with muscle invasive bladder cancer treated with radical cystectomy versus bladder preserving therapy: a nationwide study

Katharina Brück, Richard P. Meijer, Joost L. Boormans, Lambertus A. Kiemeney, J. Alfred Witjes, Lisa M.C. van Hoogstraten, Michiel S. van der Heijden, A. Rogier Donders, Martine Franckena, Carin A. Uyl- de Groot, Annemarie M. Leliveld, Katja K.H. Aben, Maarten C.C.M. Hulshof on behalf of theCRAC study group and the BLAZIB study group

Published: 28 July 2023

DOI:https://doi.org/10.1016/j.ijrobp.2023.07.027

 

Abstract

 

Background

Although level I evidence is lacking that radical cystectomy (RC) is superior to bladder preserving therapy (BPT), RC is still advocated as the recommended treatment in patients with non-metastatic muscle invasive bladder cancer (MIBC). We sought to compare the survival of patients with MIBC treated with BPT versus those treated with RC.

Methods

All patients diagnosed with non-metastatic MIBC were identified via the population-based Netherlands Cancer Registry. Only patients treated with BPT or RC were included.

The primary endpoint was 2-year disease-free survival (DFS), defined as time from start of treatment until loco-regional recurrence, distant metastasis, or death. The secondary endpoint was overall survival (OS).

We used inverse propensity treatment weighting (IPTW) based on propensity scores to adjust for baseline differences between treatment groups. Survival was analysed with Kaplan-Meier and Cox proportional hazard models.

Results

A total of 1432 patients were included, of whom 1101 underwent RC and 331 BPT. Median follow-up was 39 months (range: 27-51 months).

The IPTW adjusted 2-year DFS was 61.5% (95%CI 53.5-69.6%) with BPT and 55.3% (95%CI 51.6-59.1%) with RC, with an adjusted HR 0.84 (95%CI 0.69-1.05).

The adjusted 2-year OS for patients treated with BPT versus RC was 74.0% (95%CI 67.0-80.9%) versus 66.0% (95%CI 62.7-68.8%) respectively, with an adjusted HR of 0.80 (95%CI 0.64-0.98).

Conclusions

There was no statistically significant difference between the 2-year DFS of patients treated with BPT and RC. We propose that both RC and BPT should be offered as a curative treatment option to eligible patients with non-metastasized MIBC.